UNION OF AMERICAN PHYSICIANS AND DENTISTS LEADS STRIKE AT UNIVERSITY OF CALIFORNIA HOSPITALS

DOCTORS STRIKE at UC HOSPITALS      

For physicians work stoppage is almost unheard of -- these are the guys who treat patients under fire in war zones and whose lives are 7 years shorter than the rest of the population because of the stress entailed at being available at all hours for a lifetime. 

But now the tide has turned. Healthcare conglomerates have converted doctors into healthcare providers and often employ less trained associates to do the job -- give 'em a white coat and set 'em loose on patients while profits soar to top executives. 

It is not hard in that context to understand why UC or any other competitive company engaged in selling healthcare services and products might want to exploit its workers. Yesterday it was the garment workers. Today it is the physicians' turn. 

This time the target is the doctors who take care of the students at UC.  Over a year ago the doctors learned that they needed to be organized, not just for wages, but also to be enabled to provide the best health care they can. Over this length of time the Union of American Physicians and Dentists (UAPD) has had to contend repeatedly with unfair labor practices (ULPs) perpetrated by UC. As a result the UAPD determined that "a ULP strike is the only way to compel UC to follow the laws that govern bargaining."

Stuart A. Bussey, MD, president of the UAPD, stated that "UC has a history of disrespecting workers during negotiations, and we're no exception to that." 

Doctors at all 10 campus health centers are ready to strike. There will be six picketing sites, UC Berkeley at UHS Tang Center, UC Davis at the Student Health and Wellness Center, UC Santa Cruz at the Student Health Center, UC Irvine at the Student Health Center, UCLA at the Ashe Student Student Health and Welfare Center, and UC San Diego at Student Health Services. 

IN-STATE V. OUT-OF-STATE UTILIZATION AND INDEPENDENT MEDICAL REVIEW

OPEN LETTER TO ASSEMBLYMAN RICHARD PAN, MD
Chair, Assembly Committee on Health
15 January 2013

Dear Doctor Pan,

I am asking you to carry or sponsor legislation to repeal language within SB 863 that allows doctors who are not even licensed to practice medicine in California but who are allowed to do utilization reivew here to have their names kept secret. This secrecy is a way of making it even more difficult than it already is for injured workers to appeal wrongful denials of care.

SB 863 became effective as of 1 January 2013. An injured worker who is victimized by a stupid and harmful denial of care will not be allowed to file an appeal unless fraud, bias, or conflict of interest is suspected. The trouble is that since the legislation allows these doctors' names to be concealed, it will be truly challenging to file an appeal based on fraud, bias, or conflict of interest. The real problem, actually, is that the WCAB is no longer empowered to reverse wrongful decisions that harm injured workers. As a doctor, I don't think you would favor denials of treatment you prescribed to be done by doctors whose reports and names are not fully known to you. Am I wrong about that?

As matters stand now traditional Utilization Review does not need to be done by doctors who are licensed in California and are therefore responsible to our state medical board. Insurance companies can scour the country in search of malleable and cooperative doctors who will deny care on a myriad of technicalities no matter how harmful these denials of care are to injured workers. This injustice cannot happen in Texas. In Texas if California doctors want to do utilization review the doctors must be licensed in Texas. Since each state's medical board's jurisdiction is limited to its own state, many of the  doctors doing utilization review or independent medical review in California may not come under the medical board jurisdiction of any state at all for their UR or IMR work in California.  This largesse is estimated to cost California $10,000,000 annually --  an unwise choice for a state with financial woes.

Richard Fantozzi, MD,  as president of the California Medical Board in 2008, told Governor Schwarzenegger that this step "would provide increased consumer protection over decisions that do not have patients as its primary concern." At the request of the insurance companies and the Chambers of Commerce, Gov. Schwarzenegger vetoed a bill that would have corrected this abuse. Under similar pressure, Gov. Brown also vetoed legislation that would have corrected this abuse. SB 863 now makes the denial process even more vicious since the IMR doctors' names will be protected.

That's why treating physicians and their patients need you and like minded colleagues to amend SB 863 so that injured workers get fair and equitable access to treatment. What say you?

Yours truly,

Robert L. Weinmann, MD,  Editor, www.politicsofhealthcare.com

References

WorkCompcentral, 1/12/13, Comment by this writer to News Article by John P. Kamin, Legal Editor

Work Compcentral, 1/10/13, "Out-of-state v. In-state Utilization Review," Robert Weinmann, MD

TotalCapitol.com, 3/11/12, "Utilization Review as a gift to insurance companies," Bob Weinmann

Sports concussions, brain tumors, and legislation (Assemblymembers Hayashi and Halderman at work)

Assemblywoman Mary Hayashi has disclosed that she has a benign brain tumor that her attorney reportedly said "clouded her judgment," Mintz and Harmon, Bay Area News Group, 1/07/12. The report implies that the benign brain tumor contributed to the lapse that allowed her to walk out of Nieman-Marcus with unpaid merchandise and for which she has been convicted of a misdemeanor. We sadly acknowledge the Assemblywoman's plight and wish her well for the future.

In the meantime we've been asked how her situation compares to the situation endured by Sen. Ted Kennedy whose brain tumor was malignant and caused occasional convulsions. Kennedy's condition was inevitably fatal whereas Hayashi's is benign. The latest word from her attorney is that "it is being treated. It's no longer affecting her concentration or her judgment" (Daily Post, Jan. 7-8, 2012). Unfortunately, this statement implies that Hayashi's judgment was previously impaired during which time she authored two poorly drafted legislative bills that Gov. Brown has since signed into law (see our previous blogs).

Because the legal charge against Hayashi was reduced from a felony to a misdemeanor she will be able to keep her assembly seat and finish her term. She will pay a fine, do three years of probation, and stay at least 50 feet away from the Neiman-Marcus store. Her carelessness in creating legislation is documented well enough to repeat here.

Re AB 25 (Hayashi, re brain concussions):
This bill is now law thanks to Gov. Brown's signature. It means that athletes who sustain apparent concussions on the field must be withdrawn from play and not allowed to return until they're judged able to do so by somebody designated to make such judgments but not necessarily including neurological or neurosurgical specialists. Prior to passage of this law, healthcare professionals were at risk for civil liability better known as malpractice for wrongful decisions resulting in harm to players. Since many doctors undertook this responsibility on a pro bono (unpaid) basis, parents, schools, and teams often cut a little slack in the process. Not so anymore because the issue has now been raised to one of criminal liability. It is no longer just a civil matter to make a mistake. It is now a matter of potential criminal liability. High schools are unlikely to afford putting in place optimal protective measures, e.g., an on-site neurological specialist, ambulances and EMT vehicles discreetly parked near-by, etc.

Hayashi and staff were offered ways to improve the bill without pulling it. These offers went unanswered. The bill was supported by certain medical organizations that meant well, that intended to protect players, but that were short-sighted in their eagerness to have a seat at the legislative table. That seat has now become the hot-seat. Hayashi should offer protective amendments while she still has the chance.

AB 655 (Hayashi, transfer of peer review material): This bill, now signed into law by Gov. Brown, was also well intended; unfortunately, it was written in such a careless manner that it allows false and defamatory materials to be included with whatever peer review documentation is transferred from one hospital to another (this process is how a physician gets practice privileges at additional hospitals).

Hayashi and staff were advised about the defect in the bill and were offered language to abort the careless language in the bill. Hayashi and staff did not offer a reply. Instead, Hayashi belittled the doctors and falsely told the Assembly that there was no opposition to the bill even when there were about 50 protests already on file (none were from fellow legislators).

Linda Halderman, MD, Assemblywoman, told the Assembly that she'd received a record number of inquiries on this bill. Hayashi told the Assembly that there was no opposition. Halderman then stated that she would support the bill. We believe that Halderman should have known better, indeed, that she did know better and gave Hayashi support in a legislative charade where Halderman pretended to ask a question and then dove head first into the Hayashi camp. The shameful show got video-recorded and is still available through the Assembly itself. We can now watch for Halderman's rise in insider legislative circles (Hayashi's chair and future are in doubt even though she can finish her term). All the same, there is still time for Hayashi to seek corrective amendments to her bills. The question is whether or not she wants to do so.

In the meantime, doctors are now at risk of criminal culpability for errors in judgment and should fully understand the consequences of participating in sports activities that are associated with concussions (such as but not limited to football, hockey, soccer, boxing).